Provider Demographics
NPI:1447322151
Name:FERRELL, RONALD (OD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:FERRELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:866-795-4020
Practice Address - Street 1:2485 N COLUMBIA ST
Practice Address - Street 2:STE 118
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5421
Practice Address - Country:US
Practice Address - Phone:478-452-6569
Practice Address - Fax:478-452-6589
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA088554984BMedicaid
GA41ZCFTRMedicare ID - Type Unspecified
GAU93876Medicare UPIN
GA5673540002Medicare NSC
GA1447322151Medicare PIN